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Cut It Out: The C-Section Epidemic in America
Cut It Out examines the exponential increase in the United States of the most technological form of birth that exists: the cesarean section.
While c-section births pose a higher risk of maternal death and medical complications, can have negative future reproductive consequences for the mother, increase the recovery time for mothers after birth, and cost almost twice as much as vaginal deliveries, the 2011 cesarean section rate of 33 percent is one of the highest recorded rates in U.S. history, and an increase of 50 percent over the past decade. Further, once a woman gives birth by c-section, her chances of having a vaginal delivery for future births drops dramatically. This decrease in vaginal births after cesarean sections (VBAC) is even more alarming: one third of hospitals and one half of physicians do not even allow a woman a trial of labor after a c-section, and 90 percent of women will go on to have the c-section surgery again for subsequent pregnancies. Of comparative developed countries, only Brazil and Italy have higher c-section rates; c-sections occur in only 19% of births in France, 17% of births in Japan, and 16% of births in Finland.
How did this happen? Theresa Morris challenges most existing explanations of the unprecedented rise in c-section rates, which locate the cause of this trend in physicians practicing defensive medicine, women choosing c-sections for scheduling reasons, or women’s poor health and older ages. Morris’s explanation of the c-section epidemic is more complicated, taking into account the power and structure of legal, political, medical, and professional organizations; gendered ideas that devalue women; hospital organizational structures and protocols; and professional standards in the medical and insurance communities. She argues that there is a new culture within medicine that avoids risk or unpredictable outcomes and instead embraces planning and conservative choices, all in an effort to have perfect births. Based on 130 in-depth interviews with women who had just given birth, obstetricians, midwives, and labor and delivery nurses, as well as a careful examination of local and national level c-section rates, Cut It Out provides a comprehensive, riveting look at a little-known epidemic that greatly affects the lives, health, and families of each and every woman in America.
While c-section births pose a higher risk of maternal death and medical complications, can have negative future reproductive consequences for the mother, increase the recovery time for mothers after birth, and cost almost twice as much as vaginal deliveries, the 2011 cesarean section rate of 33 percent is one of the highest recorded rates in U.S. history, and an increase of 50 percent over the past decade. Further, once a woman gives birth by c-section, her chances of having a vaginal delivery for future births drops dramatically. This decrease in vaginal births after cesarean sections (VBAC) is even more alarming: one third of hospitals and one half of physicians do not even allow a woman a trial of labor after a c-section, and 90 percent of women will go on to have the c-section surgery again for subsequent pregnancies. Of comparative developed countries, only Brazil and Italy have higher c-section rates; c-sections occur in only 19% of births in France, 17% of births in Japan, and 16% of births in Finland.
How did this happen? Theresa Morris challenges most existing explanations of the unprecedented rise in c-section rates, which locate the cause of this trend in physicians practicing defensive medicine, women choosing c-sections for scheduling reasons, or women’s poor health and older ages. Morris’s explanation of the c-section epidemic is more complicated, taking into account the power and structure of legal, political, medical, and professional organizations; gendered ideas that devalue women; hospital organizational structures and protocols; and professional standards in the medical and insurance communities. She argues that there is a new culture within medicine that avoids risk or unpredictable outcomes and instead embraces planning and conservative choices, all in an effort to have perfect births. Based on 130 in-depth interviews with women who had just given birth, obstetricians, midwives, and labor and delivery nurses, as well as a careful examination of local and national level c-section rates, Cut It Out provides a comprehensive, riveting look at a little-known epidemic that greatly affects the lives, health, and families of each and every woman in America.
255 pages, Paperback
First published October 1, 2013
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156 people want to read
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Displaying 1 - 18 of 18 reviews
October 11, 2013
*I received an ARC from the publisher on NetGalley.*
Overall, this is a decent compilation of the c-section data and trends. Morris adds to the current conversation by including anonymous interviews with both care providers and women who have recently given birth.
My main complaint - and perhaps these things were fixed for the print edition - is the numerous grammatical errors (incomplete sentences), incorrect facts (ideal dilation rate is given as 1 cm/min rather than 1 cm/hr), and inconsistencies (such as using both "c-section" and "csection" throughout). It made me unnecessarily skeptical about the information Morris was presenting because I wondered how much of this she was cutting and pasting directly from interviews and papers versus creating her own narrative about the c-section epidemic.
I am a doula and so perhaps am not the target audience for this work, as I am more up to speed on current childbirth trends and science than the average person. But I found that I tired quickly of how repetitive the material seemed and wanted desperately to get to the solutions for the problem. I was disappointed at the cursory way the solutions were presented, almost as an afterthought to everything else.
I remain hopeful that this book - even if it wasn't really for me - will beget the change for which Morris calls, and that better outcomes for mothers and babies in childbirth will come about as a result of her work. This is a good introduction to c-section data in the United States and it is certainly a worthwhile addition to the canon.
Overall, this is a decent compilation of the c-section data and trends. Morris adds to the current conversation by including anonymous interviews with both care providers and women who have recently given birth.
My main complaint - and perhaps these things were fixed for the print edition - is the numerous grammatical errors (incomplete sentences), incorrect facts (ideal dilation rate is given as 1 cm/min rather than 1 cm/hr), and inconsistencies (such as using both "c-section" and "csection" throughout). It made me unnecessarily skeptical about the information Morris was presenting because I wondered how much of this she was cutting and pasting directly from interviews and papers versus creating her own narrative about the c-section epidemic.
I am a doula and so perhaps am not the target audience for this work, as I am more up to speed on current childbirth trends and science than the average person. But I found that I tired quickly of how repetitive the material seemed and wanted desperately to get to the solutions for the problem. I was disappointed at the cursory way the solutions were presented, almost as an afterthought to everything else.
I remain hopeful that this book - even if it wasn't really for me - will beget the change for which Morris calls, and that better outcomes for mothers and babies in childbirth will come about as a result of her work. This is a good introduction to c-section data in the United States and it is certainly a worthwhile addition to the canon.
November 4, 2013
This book should be mandatory reading for every pregnant woman and every doctor and nurse that delivers babies. I can't recommend it highly enough. It is a invaluable primer on what hospital deliveries are like and what to expect if you are hoping to have a vaginal delivery. It can also be incredibly valuable to women who have been told for various reasons that they should expect to have a c-section.
Unfortunately, today's climate of over-medicalized birth has come at the expense of evidence-based care in the name of avoiding malpractice suits. In the past, I had tended to blame doctors and a misogynistic culture for the high c-section rate, but this book opened my eyes to the wider problem of malpractice suits and avoidance of risk (of being sued, not the risk of injury to mother or baby). The doctors and nurses working under these institutional rules that prioritize avoiding malpractice suits over science are just as much victims as the moms delivering the babies. Nobody wins here.
The last chapter of the book has some good recommendations for mothers, including not agreeing to 3rd trimester ultrasounds to check for baby's weight (highly inaccurate and a frequent cause of first time c-sections) and taking independent child-birth classes instead of hospital-based classes (the hospital classes tend to focus on making women feel comfortable with interventions).
As a mom of 4, soon to be 5, children, my #1 recommendation is to get a midwife. Or at least choose your doctor AND hospital based largely on their intervention and c-section rates.
Unfortunately, today's climate of over-medicalized birth has come at the expense of evidence-based care in the name of avoiding malpractice suits. In the past, I had tended to blame doctors and a misogynistic culture for the high c-section rate, but this book opened my eyes to the wider problem of malpractice suits and avoidance of risk (of being sued, not the risk of injury to mother or baby). The doctors and nurses working under these institutional rules that prioritize avoiding malpractice suits over science are just as much victims as the moms delivering the babies. Nobody wins here.
The last chapter of the book has some good recommendations for mothers, including not agreeing to 3rd trimester ultrasounds to check for baby's weight (highly inaccurate and a frequent cause of first time c-sections) and taking independent child-birth classes instead of hospital-based classes (the hospital classes tend to focus on making women feel comfortable with interventions).
As a mom of 4, soon to be 5, children, my #1 recommendation is to get a midwife. Or at least choose your doctor AND hospital based largely on their intervention and c-section rates.
December 27, 2017
Anyone and everyone who works in pre and post natal care needs to read this! Excellent and complex information communicated effectively.
March 16, 2015
An excellent review of the facts as to why the c-section rate is rising in the US. This book does not shame women who have received c-sections, nor does it shame the doctors that perform them. It does, however, explain how our current healthcare system is more liability directed rather than patient care directed. Doctors today are forced to work within the confines of this system and this is a problem. This book is a well researched look at the facts and also offers some practical solutions to enable healthcare professionals to be able to provide a more patient centered care model. A must read for any woman of childbearing age, any healthcare professional involved in women's care, and anyone who is interested in all things birth related!
April 14, 2018
This book was clearly written and eye-opening. And anger-inducing. It seems obvious to blame obstetricians or even mothers for the ever increasing c-section rates, and while there are sometimes bad or selfish decisions made by those parties, I never thought about the organizations and policies that basically require them to act the way that they do. Maternity providers are really in a tight spot with fear of litigation over malpractice. And c-sections have somehow become the gold-standard of safety in spite of the very real dangers associated with them. This is particularly true for the mothers whose needs and safety are often set aside in the rush to spot and avoid the slightest indicator of stress or potential bad outcome for the baby. Morris really "cuts" to the heart of the problem and I applaud her efforts to create solutions. I hope more people listen and act.
November 11, 2021
This is an information dense book that reads a lot like a research paper, it is full of studies, examination of studies and trends, and interview results which is great, and also makes it a slower book to read and digest. The jist of the book is that concern over liability lawsuits for bad birth outcomes greatly influences policies and recommendations which binds both doctors in what they can offer, and women on what options are available. Probably the most helpful part of this book is the conclusion where the author lists many problems that are contributing to the C-section epidemic and solutions for each problem.
April 20, 2020
An exploration of the C section rate in America. It answers the question “why are there so many c sections in America ?” It’s from a sociologist’s perspective so a lot of statistics, interviews and other data. There’s a brief section at the end for women who want to avoid a caesarean birth.
January 17, 2021
Really powerful, informative read about C sections.
January 29, 2022
Well that's terrifying. The American healthcare system sucks.
September 2, 2023
A must read for any ob/gyn healthcare provider or pregnant woman.
July 16, 2024
A wonderful look into what expecting moms deal with while trying to bring life into the world
October 23, 2024
Important book. Must read before you or your wife gives birth.
January 19, 2019
The most charming part is that how organizational rules bring about unintended consequences.
October 11, 2013
I received a copy from the publisher via Netgalley in exchange for an honest review.
I’ve had two unplanned c-sections, so the c-section epidemic in America is definitely something I feel very strongly about, so when I saw Cut It Out on Netgalley, I didn’t even think twice and requested it immediately.
I am really struggling with a rating for Cut It Out. I mean, it’s a nonfiction book for one, but it’s also about a tough subject. It’s not a memoir with funny anecdotes and cute stories, you know? However, I think, especially in this country, that the subject matter is very important.
I had a few problems with the way the information was presented, however. First of all, I felt like a lot of the things that were expanded upon were basically common sense. I mean, realistically, I don’t think very many people would read this book unless they had a reason to. What I mean is, even though the information is hugely important, and I think every woman in America should be familiar with it, I don’t see many people seeking out this book unless they are facing or have had a c-section or have an interest in birth (such as doulas or midwives, etc). For that reason, I felt like some of the things that were expanded on (such as the stages of labor) were the things that most people already know.
Also, I was not a huge fan of the writing style. After the Introduction, every chapter/section was basically written like a high school persuasive essay with an introduction, supporting evidence, and conclusion. Due to this, I found a lot of it to be repetitive.
Aside from some of the actual numerical statistics, I felt like there was very little in Cut It Out that I didn’t already know. However, I’ve also probably read more c-section and birth books than your average person.
My favorite parts of the book were the Introduction and Conclusion. The middle part was pretty much just an expansion of things presented in the Introduction. And reading a lot of the information in this book made me angry again. It’s amazing how much resentment you can be still holding, even after half a decade, without even realizing it. And I felt like the Conclusion gave some really great suggestions on how to deal with the problem.
Even with my issues with some of the writing in Cut It Out, I did enjoy reading it, and I would definitely recommend it. I believe that the rising c-section rates in this country, and especially the reasons behind it, are very important information for everyone, but definitely for any woman even considering giving birth at some point in this country. For that reason, I’m giving it 3 stars.
Note: I did not read the Appendix or Notes at the end of the book, but those are things that I typically don’t read.
This review was originally posted on my blog: http://mommysreadingbreak.wordpress.c...
I’ve had two unplanned c-sections, so the c-section epidemic in America is definitely something I feel very strongly about, so when I saw Cut It Out on Netgalley, I didn’t even think twice and requested it immediately.
I am really struggling with a rating for Cut It Out. I mean, it’s a nonfiction book for one, but it’s also about a tough subject. It’s not a memoir with funny anecdotes and cute stories, you know? However, I think, especially in this country, that the subject matter is very important.
I had a few problems with the way the information was presented, however. First of all, I felt like a lot of the things that were expanded upon were basically common sense. I mean, realistically, I don’t think very many people would read this book unless they had a reason to. What I mean is, even though the information is hugely important, and I think every woman in America should be familiar with it, I don’t see many people seeking out this book unless they are facing or have had a c-section or have an interest in birth (such as doulas or midwives, etc). For that reason, I felt like some of the things that were expanded on (such as the stages of labor) were the things that most people already know.
Also, I was not a huge fan of the writing style. After the Introduction, every chapter/section was basically written like a high school persuasive essay with an introduction, supporting evidence, and conclusion. Due to this, I found a lot of it to be repetitive.
Aside from some of the actual numerical statistics, I felt like there was very little in Cut It Out that I didn’t already know. However, I’ve also probably read more c-section and birth books than your average person.
My favorite parts of the book were the Introduction and Conclusion. The middle part was pretty much just an expansion of things presented in the Introduction. And reading a lot of the information in this book made me angry again. It’s amazing how much resentment you can be still holding, even after half a decade, without even realizing it. And I felt like the Conclusion gave some really great suggestions on how to deal with the problem.
Even with my issues with some of the writing in Cut It Out, I did enjoy reading it, and I would definitely recommend it. I believe that the rising c-section rates in this country, and especially the reasons behind it, are very important information for everyone, but definitely for any woman even considering giving birth at some point in this country. For that reason, I’m giving it 3 stars.
Note: I did not read the Appendix or Notes at the end of the book, but those are things that I typically don’t read.
This review was originally posted on my blog: http://mommysreadingbreak.wordpress.c...
April 3, 2014
Just terrible. Written like a high school research paper with a heavy slant towards the author's hatred of organizations. Some of her arguments don't even make sense when put next to her "proof". This could have been such a great book, but it has completely fallen flat due to the author's inability to fairly portray all aspects and keep her personal views out of her reporting. View this as a work based on opinions, not straight facts. Very disappointing.
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June 27, 2014618.86 M8777 2013
July 23, 2016
Every pregnant woman or woman of reproductive age should read this book.
Displaying 1 - 18 of 18 reviews